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San Mateo County Health’s Bailey Says Its Epic Business Case Rested on the Cost of Staying Fragmented

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San Mateo County Health’s Bailey Says Its Epic Business Case Rested on the Cost of Staying Fragmented

San Mateo County Health CIO Rich Bailey explains how his team won funding and 35 permanent positions to bring its divisions onto one Epic system. Watch below or on YouTube.

San Mateo County Health won approval to extend Epic across its health divisions by showing county leaders what staying on separate systems would cost. Rich Bailey, CIO at San Mateo County Health Information Technology, purposely left a projected financial return out of the pitch because such a projection sets expectations that are hard to meet. On a recent episode of the healthsystemCIO Show, he described how a July 2025 warning led to a fall roadshow. The county’s Board of Supervisors then approved the next phase unanimously in January 2026. The same request also carried 35 permanent positions, so Epic-certified staff on temporary terms could stay for the next build.

The goal of unified systems at the county predates Epic. In 2017, then-CIO Eric Raffin told healthsystemCIO the county was “living in what has often been called best of breed” and was planning a unified EHR. Epic talks began in 2018, and the first phase went live in November 2024 for the medical center and clinics. However, seven other divisions, including behavioral health and public health, ran independently, and some relied on different systems. As a result, Bailey described the county as “essentially eight independent health systems.” Then, in July 2025, the county’s health chief told him the second phase might not move forward.

In response, the IT team went to the county health executive council and laid out what not doing Epic would cost.


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